MM Curator summary
The TN rule designed to reduce spending on inappropriate ED spending has been upheld.
The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.
The Court of Appeals in Nashville, Tenn., ruled that TennCare, the state’s Medicaid program, did not violate a state law when it imposed a $50 reimbursement limitation for nonemergent medical services provided by emergency department physicians, according to court documents filed Oct. 7.
Emergency Medical Care Facilities, a company that provides services in Tennessee emergency departments, said TennCare did not follow the correct procedure for making the $50 cap rule under the Uniform Administrative Procedures Act. The case required the appeals court to determine whether the rule falls under the UAPA.
The trial court had determined that the $50 cap rule is defined as a “rule” by the UAPA, is subject to the law’s requirements, and that TennCare did not comply with the law’s requirements for rule-making.
TennCare appealed the decision. The appeals court determined that the $50 cap rule is not subject to the UAPA because it falls under the internal management exception in the 2009 version of the law, reversing the trial court decision.